MR imaging of the lumbar spine: prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers.

AbstractBackground:Patients with lumbar spine complaints are often referred for surgical assessment. Only those with clinical and radiological evidence of nerve root compression are potential candidates for surgery and appropriate for surgical assessment. This study examines the appropriateness of lumbar spine referrals made to neurosurgeons in Edmonton, Alberta.Methods:Lumbar spine referrals to a group of ten neurosurgeons at the University of Alberta were reviewed over three two month intervals. Clinical criteria for “appropriateness” for surgical assessment were as follows: •“Appropriate” referrals were those that stated leg pain was the chief complaint, or those that described physical exam evidence of neurological deficit, and imaging reports (CT or MRI) were positive for nerve root compression. •“Uncertain” referrals were those that reported both back and leg pain without specifying which was greater, without mention of neurologic deficit, and when at least possible nerve root compression was reported on imaging. •“Inappropriate” referrals contained no mention of leg symptoms or signs of neurological deficit, and/or had no description of nerve root compression on imaging.Results:Of the 303 referrals collected, 80 (26%) were appropriate, 92 (30%) were uncertain and 131 (44%) were inappropriate for surgical assessment.Conclusions:Physicians seeking specialist consultations for patients with lumbar spine complaints need to be better informed of the criteria which indicate an appropriate referral for surgical treatment, namely clinical and radiological evidence of nerve root compression. Avoiding inappropriate referrals could reduce wait-times for both surgical consultation and lumbar spine surgery for those patients requiring it.

Download Full-text

Spinal Gas Collection Demonstrated at CT

Acta Radiologica ◽

10.1177/028418519203300202 ◽

1992 ◽

Vol 33 (2) ◽

pp. 93-96 ◽

Cited By ~ 5

Author(s):

J. Hjarbæk ◽

P. W. Kristensen ◽

P. Hauge

Keyword(s):

Lumbar Spine ◽

Epidural Space ◽

Clinical Symptoms ◽

Intervertebral Disk ◽

Surgical Results ◽

Facet Joints ◽

Disk Herniation ◽

Free Gas ◽

Ct Findings

In 234 consecutive CT examinations of the lumbar spine, gas collection was observed in 4 cases with disk herniation, and in 6 cases of disk protrusion. In 3 cases free gas was found in the epidural space, and one patient presented an intraspinal gas-filled “bleb”. Gas collection in intervertebral disk spaces and facet joints was found in a total of 60 patients. The CT findings and surgical results were compared to determine whether gas collection contributes to clinical symptoms. In most cases the presence of gas was not clinically important, but in one patient it presented as a spinal mass, causing pain and radiculopathy.

Download Full-text

Morphological and radiographic parameters of facet joints and their dependence on the grade of intervertebral disc degeneration

Genij Ortopedii ◽

10.18019/1028-4427-2020-26-4-565-570 ◽

2020 ◽

Vol 26 (4) ◽

pp. 565-570

Author(s):

A.E. Krivoshein ◽

◽

V.P. Konev ◽

S.V. Kolesov ◽

S.N. Moskovsky ◽

...

Keyword(s):

Lumbar Spine ◽

Intervertebral Disk ◽

Tissue Growth ◽

Rigid Fixation ◽

Facet Joints ◽

Grade 5 ◽

Close Relationship ◽

Radiological Changes ◽

Pfirrmann Grade ◽

Bone Structures

Objective To study morphological and radiological parameters of facet joints depending on the grade of the intervertebral disk degeneration. Materials and methods To study the facet joints of the lumbar spine in 145 patients with various grades of degeneration according to Pfirrmann and treated using rigid fixation and TLIF technology, MSCT in 2-energy mode and morphological investigation of the intraoperative material were performed. Results In Pfirrmann grade 2, an increase in the volumetric content of chondrocytes, Hounsfield density of the cartilage plate, and the level of Ca in the facet joints was visualized. They indicate that the joint remains functional. In Pfirrmann grade 5, deep pathological changes occurred with violation of the architectonics of the cartilage formations of the facet joints, formation of bone elements and connective tissue growth into the cartilage and bone structures of the joint, which correlated with the results of MSCT. Conclusion The data obtained show that there is a close relationship between morphological and radiological changes in the facet joints. Modulating the data obtained allows us to obtain objective criteria for evaluating the grade of pathological processes in facet joints and use them as a diagnostic component when planning decompression and stabilizing operations in patients with degenerative diseases of the lumbar spine.

Download Full-text

Positional MR Imaging of the Lumbar Spine: Does It Demonstrate Nerve Root Compromise Not Visible at Conventional MR Imaging?

Radiology ◽

10.1148/radiology.215.1.r00ap06247 ◽

2000 ◽

Vol 215 (1) ◽

pp. 247-253 ◽

Cited By ~ 104

Author(s):

Dominik Weishaupt ◽

Marius R. Schmid ◽

Marco Zanetti ◽

Norbert Boos ◽

Ben Romanowski ◽

...

Keyword(s):

Lumbar Spine ◽

Mr Imaging ◽

Nerve Root

Download Full-text

Chondroma of the Lumbar Spine, a Rare Cause of Sciatica: Case Report

Neurosurgery ◽

10.1227/00006123-199004000-00022 ◽

1990 ◽

Vol 26 (4) ◽

pp. 685-688 ◽

Cited By ~ 5

Author(s):

Linda I. Bland ◽

Joseph V. McDonald

Keyword(s):

Case Report ◽

Lumbar Spine ◽

Nerve Root ◽

Benign Tumor ◽

Nerve Root Compression ◽

Radicular Symptoms

Abstract A case of chondroma of the lumbar spine causing nerve root compression is presented. This benign tumor was completely removed, resulting in relief of all radicular symptoms.

Download Full-text

Disseminated intraspinal hydatid disease

Journal of Neurosurgery Spine ◽

10.3171/spi/2008/8/5/490 ◽

2008 ◽

Vol 8 (5) ◽

pp. 490-493 ◽

Cited By ~ 6

Author(s):

Yashar Moharamzad ◽

Homayoun Hadizadeh Kharazi ◽

Elham Shobeiri ◽

Gholamreza Farzanegan ◽

Forough Hashemi ◽

...

Keyword(s):

Mr Imaging ◽

Hydatid Disease ◽

Nerve Root ◽

Soft Tissues ◽

Radical Resection ◽

Surgical Removal ◽

Recurrent Nerve ◽

Nerve Root Compression ◽

Term Administration ◽

Disseminated Disease

✓Spinal echinococcosis is a rare entity, accounting for 1% of all cases of hydatid disease. The authors report the case of a 60-year-old man whom they treated for recurrent nerve root compression due to disseminated intraspinal echinococcosis (hydatid disease). Six years previously he had undergone surgery on an emergency basis at another institution after presenting with acute paraplegia due to a primary extradural hydatid cyst of the thoracic spine. Unfortunately, during surgical removal of the cysts, the echinococcosis disseminated into the spinal canal. This complication was documented by magnetic resonance (MR) imaging. In the 4 years before the authors treated him, he was hospitalized 4 times for 4 recurrences of nerve root compression. The authors treated the disseminated disease successfully with total T7–8 corpectomy, grafting with titanium cage and Texas Scottish Rite Hospital instrumentation, and long-term administration of albendazole (400 mg daily). Early diagnosis, proper utilization of MR imaging, and radical resection of diseased vertebrae and soft tissues followed by anthelmintic treatment are essential to control disseminated spinal hydatidosis and prevent recurrence.

Download Full-text

Bulging lumbar intervertebral disk: myelographic differentiation from herniated disk with nerve root compression

American Journal of Roentgenology ◽

10.2214/ajr.138.4.709 ◽

1982 ◽

Vol 138 (4) ◽

pp. 709-716 ◽

Cited By ~ 6

Author(s):

SA Kieffer ◽

RG Sherry ◽

DE Wellenstein ◽

RB King

Keyword(s):

Nerve Root ◽

Intervertebral Disk ◽

Nerve Root Compression ◽

Herniated Disk ◽

Lumbar Intervertebral Disk

Download Full-text

Magnetic resonance myelography evaluation of the lumbar spine end plates and intervertebral disks

Acta Radiologica ◽

10.1080/02841850510016036 ◽

2005 ◽

Vol 46 (1) ◽

pp. 83-88 ◽

Cited By ~ 6

Author(s):

E. Mollà ◽

L. Martí‐Bonmatí ◽

E. Arana ◽

M. C. Martinez‐Bisbal ◽

S. Costa

Keyword(s):

Lumbar Spine ◽

Magnetic Resonance ◽

Intervertebral Disk ◽

End Plate ◽

Intervertebral Disks ◽

Fatty Metamorphosis ◽

Intervertebral Level ◽

Mr Myelography ◽

Good Agreement

Purpose: To evaluate the value of magnetic resonance (MR) myelography in the evaluation of intervertebral disk and end‐plate degenerative changes in the lumbar spine. Material and Methods: Conventional MR and MR myelography examinations were performed in 150 consecutive patients (69 F and 81 M, mean age 45±15 years, range 18–89). Sagittal T1 and T2‐weighted TSE images were compared to MR myelography obtained with a multishot‐TSE‐T2‐weighted sequence (4000/250/fat suppression). Coronal, sagittal, and both oblique MR myelography projections were obtained. Image analysis was carried out independently by two radiologists who categorized lumbar disks into normal, degenerated, or edematous; and vertebral end plates into normal, edematous, or with fatty changes. The proportions were statistically compared at every lumbar intervertebral level. Results: There was good agreement in the classification of disk disease (Kappa: 0.8–0.9). MRI detected a larger number of disk degeneration and end‐plate fatty metamorphosis, while the MR myelography technique depicted a larger number of edematous disks and end plates. Conclusion: MR myelography was of limited value in detecting the same vertebral end‐plate changes observed in MRI, although with similar findings in disk disease. However, the higher detection of edema changes by MR myelography should be analyzed prospectively, as it could be more sensitive than conventional MR sequences.

Download Full-text